To give a Canadian perspective:
There are two paths to EM in Canada.
The first path is a three year course, consisting of two years of family medicine followed by a one year fellowship in EM (usually consisting of rotations in EM, surgical specialities, trauma, etc).
The second path is a five year program that includes extensive rotations in Internal medicine, surgical subspecialites, trauma, research and a mini-fellowship (about one year) in a subspecialty of EM.
The common belief is that ten years out of residency, graduates from either program are indistinguishable. However, before that time, five year graduates tend to be more comfortable with trauma and are usually more comfortable working in academics as well.
It is predicted that eventually five year grads will work in the tertiary-care hospitals (which are usually the trauma centers in Canada) while the three year grads will tend to work in the community hospitals.